• The Global Mental Health Assessment Tool Primary Care and General Health Setting Version (GMHAT/PC) – Spanish version: A validity and feasibility study

      Tejada, Paola; Jaramillo, Luís Eduardo; Marulanda, Jefferson; Sharma, Vimal; University of Chester; National University of Colombia; Cheshire and Wirral NHS Foundation Trust (University of Zaragoza, 2016-08)
      The study aims to assess the feasibility of using a computer assisted diagnostic interview by GPs and to examine the level of agreement between the Spanish version GMHAT/PC diagnosis and psychiatrists' ICD-10 based clinical diagnosis. Participants in the study ranged from those who were in remission to others who had different mental illnesses. They were recruited from inpatient and outpatient mental health settings. All consecutive patients were interviewed using Spanish version of GMHAT/PC and they were assessed independently by psychiatrists to in order to get their ICD-10 based diagnosis. Two hundred ninety-nine patients participated in the study. The mean duration of interview was 12.5 minutes. There is an acceptable to good level of agreement between the GP’s (GMHAT/PC) diagnoses and the psychiatrists’ (clinical) diagnoses of any mental illness, Kappa 0.58 95% C.I (0.46, 0.72). There is good level of sensitivity (81%) and specificity (92%), with GPs correctly identifying 242 out of the 250 participants diagnosed with mental illness and 27 out of 35 of those without. The finding of the study suggest that GMHAT/PC Spanish version used by GPs detected mental disorders accurately and it was feasible to use GMHAT/PC (Spanish version) in Latin America settings.
    • Promoting a healthy diet in young adults: The role of nutrition labelling

      Buyuktuncer, Zehra; Ayaz, Aylin; Dedebayrakta, Damla; Inan-Eroglu, Elif; Ellahi, Basma; Besler, Halit Tanju; Hacettepe University; University of Chester; Eastern Mediterranean University (MDPI, 2018-09-20)
      The use of the nutrition facts label has been associated with healthy eating behaviours for adults. However, the relationship between nutrition facts label use and overall diet quality is not well known in young adults, a vulnerable group that acquire lifelong eating behaviours during this period of life. This study aimed to assess if the use of information on the nutrition facts label is associated with a higher diet quality in young adults. In this cross-sectional study, 958 university students, aged 18-34 years were recruited. Nutrition facts label use was recorded. Dietary intake was assessed using 24-hour dietary recall. Healthy Eating Index-2005 (HEI-2005) scores were calculated. HEI-2005 score was significantly associated with using nutrition facts label (P < 0.001). The mean total HEI-2005 score was 60.7±10.11, 62.4±11.43 and 67.1±12.23 respectively for Never, Sometimes and Every time users of nutrition facts label (P < 0.001). Subgroup scores of HEI-2005 for total fruits, whole fruits, total vegetables, whole grains, milk, oils, saturated fat, and calories from solid fat, alcohol and added sugar (SoFAAS) were significantly higher in regular nutrition facts label users (P < 0.05, for each). This study showed that young adults who regularly use nutrition facts label have a higher diet quality.
    • Visual Perceptions of Ageing; A Longitudinal Mixed Methods Study of UK Undergraduate Student Nurses’ Attitudes and Perceptions Towards Older People.

      Ridgway, Victoria; Mason-whitehead, Elizabeth; Mcintosh-Scott, Annette; University of Chester (Elsevier, 2018)
      Ageism and negative attitudes are said to be institutionally embedded in healthcare during a time when there are unprecedented increases in older population numbers. As nurses’ care for older people in a range of environments it was timely to examine attitudes and perceptions of undergraduate nurses towards older people. A longitudinal mixed methods study in conjunction with a three-year undergraduate UK nursing programme 2009-2012 was conducted with 310 undergraduate nurses. A questionnaire incorporating Kogan’s attitude towards older people scale and a drawing of a person aged 75 years was completed three times, once each year. Thurstone scale and photo elicitation were also employed. Comparisons were made between individual participant’s attitude score and drawing. The study established 75% of participants had moderately positive attitudes towards older people when the programme began, at the programme end this had increased to 98%. Age, gender, educational qualifications, practice learning, nursing field and contact with older people influenced participants’ overall attitude score. Drawings provided a visual narrative of participants’ perceptions of older people, appearance was a dominant discourse and the images were socially constructed. The study established the undergraduate nursing programme influenced attitudes and perceptions towards older people and suggests nurse education can influence changing attitudes. To date there is no known study that has advanced this understanding.
    • Elderly Persons Health and Wellbeing

      Ridgway, Victoria; University of Chester (2018)
      This chapter considers older persons’ health and wellbeing. As the world population changes there are global challenges to ensure that health and social care systems, individuals, communities and countries meet the needs of older people so that they are empowered to lead active and connected later lives. However, these opportunities are heavily dependent on two fundamental characteristics that of good health and wellbeing and healthy ageing. The conceptualisation of ‘being old or older’ first needs to be considered. The use of 65 as a parameter to measure old age is a political and social construct. Baar et al. (2014) for example noted the tendency to use 60 to 65 as the entrance point to old age and although useful to establish understanding writers in the field of gerontology have argued against such use. Culturally older age can occur from 50 upwards (Baar et al. 2014) as consequence of poor health, education, financial situation and environment and there is no typical older person (World Health Organisation (WHO) 2018a). Other authors have defined no age categorisation boundaries but have referred to a third and fourth age. The third age being conceptualised as a life period full of opportunity and good health and wellbeing, whilst the fourth age is perceived as a period of decline, increasing dependency and ultimately death (Higgs and Gilleard 2015). Therefore, being older is difficult to define and for this chapter 60 will be used as a ‘marker of old age’. There are two lenses from which society view and perceive older people, first by some they are considered a burden, a drain on resources and are less valued. Alternatively, older people are considered wise, dependable individuals who contribute to society, local communities and family life. The increasing older demographic has both immense potential for society but also comes with challenges. This chapter will explore population growth, perceptions of ageing, health and wellbeing in later life, factors that negate against healthy ageing and will end with preventive strategies
    • Some ethical limitations of privatisation within social work and social care in England for children and young people

      Carey, Malcolm; University of Chester (Routledge, 2019-04-01)
      The article considers some of the ethical impications of the ongoing privatisation of social care and social work services.
    • An evaluation of cognitive stimulation therapy sessions for people with dementia and a concomitant support group for their carers.

      Bailey, Jan; Kingston, Paul; Alford, Simon; Taylor, Louise; Tolhurst, Edward; University of Chester; Staffordshire University (SAGE, 2016-01-18)
      This research aimed to ascertain the impact of a pragmatic Cognitive Stimulation Therapy course of ten sessions on the cognitive function of people living with dementia and whether attending a concomitant carers support group was beneficial to carers. A mixed method quasi-experimental approach was adopted, data was collected pre and post intervention. The quantitative arm utilised three validated questionnaires rated by the carers. Qualitative data was collected via semi-structured interviews with carers regarding their perceptions of the impact of Cognitive Stimulation Therapy and the carers support group Quantitative data analysis found no statistically significant differences within or between groups. The qualitative data demonstrated that carers perceived Cognitive Stimulation Therapy had some benefits for the people living with dementia, especially social benefits. Carers also perceived that attending the carers support group was beneficial for them in terms of gaining a better understanding of dementia, developing coping skills and having peer support. The study was limited in scale and further research with a larger sample, using direct measures of the impact of Cognitive Stimulation Therapy with people living with dementia and supplementary research exploring which characteristic of carers support groups are effective would be worthwhile
    • Web-Based STAR E-Learning Course Increases Empathy and Understanding in Dementia Caregivers: Results from a Randomized Controlled Trial in the Netherlands and the United Kingdom

      Hattink, Bart; Meiland, Franka; van der Roest, Henriëtte; Kevern, Peter; Abiuso, Francesca; Bengtsson, Johan; Giuliano, Angele; Duca, Annalise; Sanders, Jennifer; Basnett, Fern; Nugent, Chris; Kingston, Paul; Dröes, Rose-Marie; University Medical Center Amsterdam; Staffordshire University; Medea; Internit; Across Limits; University of Ulster; University of Chester. (JMIR Publications, 2015-10-30)
      Background: The doubling of the number of people with dementia in the coming decades coupled with the rapid decline in the working population in our graying society is expected to result in a large decrease in the number of professionals available to provide care to people with dementia. As a result, care will be supplied increasingly by untrained informal caregivers and volunteers. To promote effective care and avoid overburdening of untrained and trained caregivers, they must become properly skilled. To this end, the European Skills Training and Reskilling (STAR) project, which comprised experts from the domains of education, technology, and dementia care from 6 countries (the Netherlands, Sweden, Italy, Malta, Romania, and the United Kingdom), worked together to create and evaluate a multilingual e-learning tool. The STAR training portal provides dementia care training both for informal and formal caregivers. Objective: The objective of the current study was to evaluate the user friendliness, usefulness, and impact of STAR with informal caregivers, volunteers, and professional caregivers. Methods: For 2 to 4 months, the experimental group had access to the STAR training portal, a Web-based portal consisting of 8 modules, 2 of which had a basic level and 6 additional modules at intermediate and advanced levels. The experimental group also had access to online peer and expert communities for support and information exchange. The control group received free access to STAR after the research had ended. The STAR training portal was evaluated in a randomized controlled trial among informal caregivers and volunteers in addition to professional caregivers (N=142) in the Netherlands and the United Kingdom. Assessments were performed with self-assessed, online, standardized questionnaires at baseline and after 2 to 4 months. Primary outcome measures were user friendliness, usefulness, and impact of STAR on knowledge, attitudes, and approaches of caregivers regarding dementia. Secondary outcome measures were empathy, quality of life, burden, and caregivers’ sense of competence. Results: STAR was rated positively by all user groups on both usefulness and user friendliness. Significant effects were found on a person-centered care approach and on the total score on positive attitudes to dementia; both the experimental and the control group increased in score. Regarding empathy, significant improvements were found in the STAR training group on distress, empathic concern, and taking the perspective of the person with dementia. In the experimental group, however, there was a significant reduction in self-reported sense of competence. Conclusions: The STAR training portal is a useful and user-friendly e-learning method, which has demonstrated its ability to provide significant positive effects on caregiver attitudes and empathy.
    • Layers of listening: qualitative analysis of the impact of early intervention services for first-episode psychosis on carers’ experiences

      Anna, Lavis,; Lester, Helen; Everard, Linda; Freemantle, Nicholas; Amos, Tim; Fowler, David; Hodgekins, Jo; Jones, Peter; Marshall, Max; Sharma, Vimal; Larsen, John; McCrone, Paul; Singh, Swaran; Smith, Jo; Birchwood, Max (Cambridge University Press, 2015-08)
      Background: Early Intervention Services (EIS) comprise low-stigma youth-friendly mental health teams for young people undergoing first-episode psychosis (FEP). Engaging with the family of the young person is central to EIS policy and practice. Aims: By analysing carers’ accounts of their daily lives and affective challenges during a relative’s first-episode psychosis against the background of wider research into Early Intervention Services, this paper explores relationships between carers’ experiences and EIS. Methods: Semi-structured longitudinal interviews with 80 carers of young people with FEP treated through English EIS. Results: Our data suggest that EIS successfully aid carers to support their relatives, particularly through the provision of knowledge about psychosis and medications. However, paradoxical ramifications of these service user-focused engagements also emerge; they risk leaving carers’ emotions unacknowledged and compounding an existing lack of helpseeking. Conclusions: By focusing on EIS’s engagements with carers, this paper draws attention to an urgent broader question; as a continuing emphasis on care outside the clinic space places family members at the heart of the care of those with severe mental illness, we ask: who can, and should, support carers, and in what ways?
    • Psychiatric morbidity in medically ill patients using Spanish version of GMHAT/PC

      Tejada, Paola A.; Jaramillo, Luís Eduardo; Polo, Gilberto; Sharma, Vimal; University of Chester (Taylor and Francis, 2016-12-14)
      The study aimed to assess psychiatric morbidity in medically ill patients and to examine the use of GMHAT/PC Spanish version in a general health setting. We recruited patients who were hospitalized at the services of Internal Medicine, Surgery and G/O during a period of 1 month for each service. The diagnosis of a medical illness was supported by specialists in each service. A trained GP conducted a psychiatric assessment of all the participants using GMHAT/PC. The interview was carried out at patients’ bedside. Of 455 medically ill patients, 4.8% had a mental illness identified by GMHAT/PC interview. Anxiety, depression and organic disorders were the most frequently identified mental disorders in internal medicine and surgery. Cancer had a significantly higher prevalence of comorbid mental illness. In this study the proportion of medically ill with mental disorders was less compared to other studies. The GMHAT/PC is more close to identifying clinical cases of mental illness and also patients who need help. The GMHAT is more a diagnostic instrument than a screening instrument. Physicians and practitioners can be trained to identify mental illness using computer-assisted tools such as GMHAT/PC. A holistic approach of providing care to such patients may improve their overall outcome and quality of life.
    • Social recovery therapy in combination with early intervention services for enhancement of social recovery in patients with first-episode psychosis (SUPEREDEN3): a single-blind, randomised controlled trial

      Fowler, David; Hodgekins, Jo; French, Paul; Marshall, Max; Freemantle, Nick; McCrone, Paul; Everard, Linda; Lavis, Anna; Jones, Peter; Amos, Tima; Singh, Swaran; Sharma, Vimal; Birchwood, Max; University of Sussex; University of East Anglia; Greater Manchester Mental Health NHS Trust; University of Liverpool; Lancashire Care NHS Foundation Trust; University College London; King’s College London; Birmingham and Solihull NHS Mental Health Foundation Trust; University of Birmingham; University of Cambridge; University of Bristol; University of Warwick; University of Chester; Cheshire and Wirral Partnership NHS Foundation Trust (Elsevier, 2017-12-11)
      Background - Provision of early intervention services has increased the rate of social recovery in patients with first episode psychosis; however, many individuals have continuing severe and persistent problems with social functioning. We aimed to assess the efficacy of early intervention services augmented with social recovery therapy in patients with first-episode psychosis. The primary hypothesis was that social recovery therapy plus early intervention services would lead to improvements in social recovery. Methods - We did this single-blind, phase 2, randomised controlled trial (SUPEREDEN3) at four specialist early intervention services in the UK. We included participants who were aged 16–35 years, had non-affective psychosis, had been clients of early intervention services for 12–30 months, and had persistent and severe social disability, defined as engagement in less than 30 h per week of structured activity. Participants were randomly assigned (1:1), via computer-generated randomisation with permuted blocks (sizes of four to six), to receive social recovery therapy plus early intervention services or early intervention services alone. Randomisation was stratified by sex and recruitment centre (Norfolk, Birmingham, Lancashire, and Sussex). By necessity, participants were not masked to group allocation, but allocation was concealed from outcome assessors. The primary outcome was time spent in structured activity at 9 months, as measured by the Time Use Survey. Analysis was by intention to treat. This trial is registered with ISRCTN, number ISRCTN61621571. Findings Between Oct 1, 2012, and June 20, 2014, we randomly assigned 155 participants to receive social recovery therapy plus early intervention services (n=76) or early intervention services alone (n=79); the intention-to-treat population comprised 154 patients. At 9 months, 143 (93%) participants had data for the primary outcome. Social recovery therapy plus early intervention services was associated with an increase in structured activity of 8·1 h (95% CI 2·5–13·6; p=0·0050) compared with early intervention services alone. No adverse events were deemed attributable to study therapy. Interpretation - Our findings show a clinically important benefit of enhanced social recovery on structured activity in patients with first-episode psychosis who received social recovery therapy plus early intervention services. Social recovery therapy might be useful in improving functional outcomes in people with first-episode psychosis, particularly in individuals not motivated to engage in existing psychosocial interventions targeting functioning, or who have comorbid difficulties preventing them from doing so.
    • Nutrition Knowledge, Dietary Patterns and Anthropometric Indices of Older Persons in Four Peri-urban Communities in Ga West Municipality, Ghana

      Faith Agbozo; Joyce Amardi-Mfoafo,; Helen Dwase; Basma Ellahi; Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana; Department of Family and Consumer Sciences, College of Agriculture and Consumer Sciences, University of Ghana, Legon, Accra ; Faculty of Health and Social Care, University of Chester, Chester, CH1 4BJ, UK. (African Health Sciences, 2018-09-30)
      ABSTRACT Background: Older adults are vulnerable to malnutrition due to sociologic, physiologic and anatomical effects of ageing. Objective: To investigate the influence of nutrition knowledge and dietary patterns on nutritional status of community-dwelling ambulatory older adults. Methods: This cross-sectional survey involved 120 elderly aged 60-70 years purposively selected from four peri-urban communities in Ga West municipality, Ghana. Nutrition knowledge was assessed using a structured questionnaire and dietary intakes obtained using a standardized food frequency questionnaire. BMI from weight/height measurements was proxy for nutritional status. Data was analyzed descriptively in SPSS. Associations were tested using correlation analyses (-1
    • Enhancing practice teachers’ knowledge and skills using collaborative action learning sets

      Haydock, Deborah; Evers, Jean; University of Chester (Community Practitioner, 2014-06-23)
      This research project was designed to enhance the critical thinking and problem-solving skills of practice teachers (PTs) and promote role modelling to specialist community public health nursing (SCPHN) students. This paper explores the impact of action learning sets (ALS) on the trainee PT role and associated students and stakeholders. Pre- and post-intervention surveys were completed by eight trainee PTs and three focus groups were held consisting of trainee PTs, practice education facilitators and students. Three focus groups for the trainee PTs, practice education facilitators and allocated students were held. Findings are presented in relation to three themes: knowledge, skills and role modelling in practice; dedicated practice teacher development; and ALS in practice. Data analysis demonstrated that the PTs valued the dedicated module and ALS enhanced their knowledge and skills. These skills were role modelled to students to guide reflection and knowledge acquisition. All participants intended to develop ALS as part of continued professional development. The paper concludes with recommendations to improve the educational development of both trainee and experienced PTs through the integration of ALS as part of PT development.
    • CPTs’ perceptions of their role satisfaction and levels of professional burnout

      Haydock, Deborah; Mannix, Jean; Gidman, Janice; University of Chester (Community Practitioner, 2011-05-19)
      This paper reports on a multi-method research project that explored perceived role satisfaction and professional burnout among community practice teachers (CPTs) while facilitating postregistration education and caseload management. A bespoke Satisfaction Questionnaire and the Maslach Burnout Inventory (Educators) were completed by 23 participants to elicit quantitative and qualitative data. Findings are presented in relation to three themes – aspects of the CPT role leading to satisfaction, aspects leading to dissatisfaction or burnout, and ways to enhance satisfaction and reduce burnout. The majority of CPTs were satisfied with their current role. A number of factors were elicited that affected participants’ perceived satisfaction. Respondents scored low levels of burnout overall, with high levels of personal accomplishment and low levels of depersonalisation. The relationship between participants’ satisfaction and their levels of burnout was not found to be statistically significant. However, mean scores on the emotional exhaustion subscale indicate moderate levels of emotional exhaustion. The paper concludes with recommendations to improve the support provided by employers and partner universities for CPTs.
    • Cost-effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance

      Radhakrishnan, Muralikrishnan; McCrone, Paul; Lafortune, Louise; Everard, Linda; Fowler, David; Amos, Tim; Freemantle, Nick; Singh, Swaran P.; Marshall, Max; Sharma, Vimal; Lavis, Anna; Jones, Peter B.; Birchwood, Max; King's College; University of Cambridge; Birmingham and Solihul Mental Health NHS Foundation Trust; University of Sussex; University of Bristol; University College London; University of Warwick; University of Manchester; Cheshire and Wirral NHS Foundation Trust and University of Chester; University of Birmingham (Wiley, 2017-08-31)
      Introduction Early Intervention Services (EIS) for psychosis are being implemented, internationally. It is important to learn from established examples and define the components and intensity of services that provide good value for money. This study aims to assess the cost-effectiveness of EIS according to how closely they adhered to the recommendations of the English Department of Health 2001 Policy Implementation Guide (PIG). Methods EIS from the National Eden Study were assessed using a measure of fidelity to the PIG that rated the presence or absence of 64 recommended items relating to team structure and practice. EIS were then classified into three groups: those with fidelity of 75-80 %, 81%-90 %, and 91-95 %. Patient-level resource use and outcomes were measured one year following inception into the service; costs were calculated and combined with quality-adjusted life years (QALYs) gained. Results At a threshold of £20,000 per QALY, the 81-90% fidelity group had a 56.3% likelihood of being the most cost-effective option followed by 75-80% fidelity at 35.8% and 91-95% fidelity group (7.9%). Conclusions The results from England suggest that striving to maximise fidelity may not be warranted, but that dropping below a certain level of fidelity may result in inefficient use of resources.
    • The impact of severe haemophilia and the presence of target joints on health-related quality-of-life

      O’Hara, Jamie; Walsh, Shaun; Camp, Charlotte; Mazza, Giuseppe; Carroll, Liz; Hoxer, Christina; Wilkinson, Lars; University of Chester; HCD Economics; University College London; The Haemophilia Society; Novo Nordisk (BioMed Central, 2018-05-02)
      Background: Joint damage remains a major complication associated with haemophilia and is widely accepted as one of the most debilitating symptoms for persons with severe haemophilia. The aim of this study is to describe how complications of haemophilia such as target joints influence health-related quality of life (HRQOL). Methods: Data on hemophilia patients without inhibitors were drawn from the ‘Cost of Haemophilia across Europe – a Socioeconomic Survey’ (CHESS) study, a cost-of-illness assessment in severe haemophilia A and B across five European countries (France, Germany, Italy, Spain, and the UK). Physicians provided clinical and sociodemographic information for 1285 adult patients, 551 of whom completed corresponding questionnaires, including EQ-5D. A generalised linear model was developed to investigate the relationship between EQ-5D index score and target joint status (defined in the CHESS study as areas of chronic synovitis), adjusted for patient covariates including socio-demographic characteristics and comorbidities. Results: Five hundred and fifteen patients (42% of the sample) provided an EQ-5D response; a total of 692 target joints were recorded across the sample. Mean EQ-5D index score for patients with no target joints was 0.875 (standard deviation [SD] 0.179); for patients with one or more target joints, mean index score was 0.731 (SD 0.285). Compared to having no target joints, having one or more target joints was associated with lower index scores (average marginal effect (AME) -0.120; SD 0.0262; p < 0.000). Conclusions: This study found that the presence of chronic synovitis has a significant negative impact on HRQOL for adults with severe haemophilia. Prevention, early diagnosis and treatment of target joints should be an important consideration for clinicians and patients when managing haemophilia.
    • Cannabis use is associated with increased psychotic symptoms and poorer psycho-social functioning in first-episode psychosis: A report from the UK National EDEN study

      Seddon, Jennifer L.; Birchwood, Max; Copello, Alex; Everard, Linda; Jones, Peter B.; Fowler, David; Amos, Tim; Freemantle, Nick; Sharma, Vimal; Marshall, Max; Singh, Swaran P.; University of New South Wales; University of Warwick; University of Birmingham; Birmingham and Solihull Mental Health NHS Foundation Trust; Cambridge and Peterborough NHS Foundation Trust; University of Sussex; University of Bristol; UCL Medical School; University of Chester; University of Manchester; (Oxford University Press, 2015-11-04)
      Background: The use of cannabis during the early stage of psychosis has been linked with increased psychotic symptoms. This study aimed to examine the use of cannabis in the 12 months following a first-episode psychosis (FEP) and the link with symptomatic course and outcome over one year post psychosis onset. Method: 1027 FEP patients were recruited upon inception to specialised early intervention services for psychosis in the UK. Participants completed assessments at baseline, six and twelve months. Results: The results indicate that the use of cannabis was significantly associated with increased severity of psychotic symptoms, mania, depression and poorer psycho-social functioning. Continued use of cannabis following the first episode of psychosis was prognostic of outcome at one year. These associations were significant after adjusting for age, gender, DUP, age of psychosis onset, ethnicity and other drug use. Conclusion: This is the largest cohort study of first-episode psychosis patients receiving care within early intervention services. Cannabis use, in particular continued use, is associated with poorer symptomatic and functional outcome during the first-episode of psychosis. The results highlight the need for effective and early intervention for cannabis use in FEP.
    • The Healthy Futures Project

      Rabie, Gabrielle; Evers, Jean; Olsen, Veronica; Byrne, Kevin; University of Chester (Gay Rabie, Jean Evers, Veronica Olsen, K.Byrne, 2017)
      This article discusses the formation of the Healthy Futures Network which is an informal network of schools in the North West who began meeting over a period of several months seeking to address issues relating to the Health and Wellbeing of young people. The health focus was mainly on Obesity and Physical activity. There was however a recognition of the need to address underlying contribution factors relating to health and wellbeing. In 2014, this informal “Network” became the ‘Healthy Futures Network’, a cross-sector partnership between the University of Chester and 8 schools from the North West of England funded by Health Education England (North). The Project was designed to assess how a collaborative network of schools at a regional/sub-regional level could work together to promote health and wellbeing, and to improve emotional health and wellbeing of their pupils. This project was also part of an engagement strategy for raising aspiration and awareness of potential career education opportunities within the NHS.
    • Is living well with dementia a credible aspiration for spousal carers?

      Tolhurst, Edward; Carey, Malcolm; Weicht, Bernhard; Kingston, Paul; Stafford University; University of Chester; University of Innsbruck; UOC (Taylor & Francis, 2018-05-21)
      In England there has been substantial policy development and an academic drive to promote the goal of ‘living well’ for people with dementia and their family members. This article critically evaluates the feasibility of this intention, with reference to the experience of those caring for people with the condition. Qualitative data are utilised from a study which explored how couples negotiate relationships and care. The focus of this paper is the perspectives of spousal carers and the challenges they encounter within their caring role. Views were obtained via semi-structured joint interviews where the carer participated alongside the person with dementia. The extent to which living well with dementia is a credible aspiration for carers is examined via three themes: identity subsumed under care responsibilities; the couple as an isolated family unit; and barriers to professional support. The findings highlight that experience of caring is highly complex and fraught with multiple practical, emotional and moral pressures. It is asserted that research into dementia and care relationships must avoid a zero sum situation, prompted by living well discourses, where attempts to bolster the position of people with dementia compound the marginalisation and stigmatisation of informal carers.
    • Finding the Forgotten: Motivating Military Veterans to Register with a Primary Healthcare Practice

      Finnegan, Alan; Jackson, Robin; Simpson, Robin; University of Chester; NHS Bury Clinical Commissioning Group; Ministry of Defence Deanery (Oxford University Press, 2018-05-09)
      Introduction: In the UK, primary healthcare practices choose from a series of Read codes to detail certain characteristics onto a patient's medical documentation. One of these codes is for military veterans indicating a history relating to military service. However, veterans are poor at seeking help, with research indicating that this code is only applied in 7.9% of cases. Clinical staff have a clear role in motivating veterans to declare their ex-Forces status or register with a primary healthcare center. The aim of this study was to motivate veterans to notify primary healthcare staff of their armed forces status or register with a general practitioner, and to improve primary healthcare staff's understanding of veterans' health and social care issues. Materials and Methods: Data were provided by four primary healthcare centers' containing 40,470 patients in Lancashire, England during 2017. Pre- and post-patient medical record Read Code searches were conducted either side of a 6-wk intervention period centered on an advertising campaign. The data identified those veterans with the military specific Read code attached to their medical record and their age, gender, marital status and mental health disorders. Further information was gathered from interviews with eight members of staff, some of whom had completed an e-learning veteran healthcare academic module. The study was approved by the University of Chester's Research Ethics Committee. Results: The pre-intervention search indicated that 8.7% (N = 180) of veterans were registered and had the correct military specific code applied to their medical record. Post-intervention, this figure increased by nearly 200% to N = 537. Mental health disorders were present in 28% (N = 152) of cases, including 15% (N = 78) with depression. Interviews revealed the primary healthcare staff's interpretation of the factors that motivated patients to declare their ex-Forces status and the key areas for development. Conclusion: The primary healthcare staff took ownership and responsibility for this initiative. They were creative in introducing new ways of engaging with the local armed forces community. Many veterans' and staff were unaware of veterans' entitlement to priority medical services, or the wider provisions available to them. It is probable that veterans declaring their military status within primary healthcare, or registering with a general practitioner for the first time is likely to increase. Another review will be undertaken after 12 mo, which will provide a better indication of success. There remains however an ongoing need to reach out to those veterans who never access a primary healthcare practice. This paper adds to the limited international empirical evidence undertaken to explore help-seeking behavior in an armed forces community. The positive outcomes of increased awareness and staff commitment provide a template for improvement across the UK, and will potentially stimulate similar initiatives with international colleagues.
    • Nurse Education and the Military Veteran

      Finnegan, Alan; Currie, Jane; Ryan, Teresa; Steen, Mary; University of Chester; University of Sidney; Northwest Florida State College; University of South Australia (Australian Nursing & Midwifery Federation, 2018-04-23)
      No occupation is more dangerous than serving in a nation’s armed forces, where service-personnel may face atrocious conditions and events. Some experience mental health problems including Post Traumatic Stress Disorder, depression and anxiety. The spouse and children are exposed to frequent moves, and endure long periods separated from a partner or parent. Nurses are well placed to make a substantial difference in the care of veterans and their families, although many Veterans believe healthcare professionals “cannot understand” their experiences (Finnegan et al, 2017). To change this narrative, the UK has introduced a new under-graduate educational initiative. An initial single site pilot study was undertaken at the University of Chester, England in 2017. The aim was to produce educational sessions that provided student nurses with an insight into the Armed Forces Community (AFC) of serving personnel, veterans and their families, and construct an understanding of the biopsychosocial needs aligned to their care, health and wellbeing. The intent was to stimulate critical thinking to focus on the individual and family needs by encouraging a problem solving approach.